Female Bladder 405 



divisions of the internal iliac trunks, and from the uterine branches. 

 The front and back of the vagina also derive twigs from the vesical 

 and haemorrhoidal vessels respectively ; and the entrance receives 

 twigs from the internal pudic. The lymphatics pass to the pelvic 

 glands. The nerves come from the vesical, haemorrhoidal, and uterine 

 ramifications, and from the hypogastric plexus itself. 



As shown on p. 389, the upper part of the vagina is separated from 

 the rectum by the retro-uterine pouch of peritoneum, which thus gives 

 a partial serous covering to the vagina ; there is no peritoneum upon 

 the front wall. I have known the peritoneal cavity opened in paring 

 the edges of a fistulous communication between the upper part of the 

 vagina and the rectum, some shreds of omentum appearing in the 

 vagina. When epithelioma attacks the upper part of the posterior 

 wall of the vagina the peritoneal cavity is quickly invaded, fatal peri- 

 tonitis being entailed. A loop of small intestine may be driven in 

 this pouch to bulge into the upper part of the vagina, constituting a 

 'vaginal liernia. 



The female bladder is placed behind the pubes and the triangular 

 ligament, and in front of the vagina ; and, when distended, it ascends in 

 front of the uterus, being separated from it by a pouch of peritoneum. 

 As there is no prostate gland, and as the base of the bladder is 

 separated from the concavity of the rectum by the vagina, there is no 

 pouch behind the vesical outlet in which urine can collect. The base 

 of the bladder can be thoroughly explored by the sound when the 

 index-finger is in the vagina, and in this way the presence of even 

 small papillomatous growths may be detected. But, as remarked 

 above, the finger may be conveniently passed into the bladder for the 

 purpose of examination. 



On account of the size of the urethra, cystitis and vesical calculus 

 are rarely met with, and urethritis is uncommon. In crushing a stone, 

 the lithotrite should be placed to one side of the elevation which the 

 neck of the uterus may form at the back of the bladder. 



The base of the bladder is closely adherent to the front of the 

 vagina, without, of course, the intervention of any peritoneum ; and 

 in amputation of the cervix uteri by the ecraseur it has happened that 

 part of the anterior vaginal wall and of the floor of the bladder have 

 been accidentally included in the noose and taken away. By the inter- 

 vention of the vagina and uterus between the bladder and rectum 

 the female bladder has less of a peritoneal coat than that of the male. 

 As in the male, there is no peritoneum on the anterior or antero-lateral 

 aspect. 



For chronic and intractable cystitis free dilatation of the urethra 

 and irrigation of the bladder may be unhesitatingly performed, but 

 vaginal cystotomy can rarely be necessary. 



Retention of urine in the female, except from hysteria, or after par- 

 turition, or after an operation upon the rectum, is rare, because of the 



